All-suture suture anchor systems and methods

ABSTRACT

An all-suture suture anchor system includes an all-suture anchor, an inserter, and a specially designed drill. The drill is used to enlarge the hole and create a pocket under the bone surface from the pre-drilled hole. The created pocket is intended to accommodate the expansion of the anchor when deployed into the bone, generating a true mechanical interference under the bone surface. The anchor is loaded on the inserter and placed at full length vertically inside the drilled hole. While holding the inserter on top of the drilled hole, so that a feature on the inserter keeps the anchor to a desired depth below the bone surface, tension is applied to the suture limb that is connected to the bottom end of the anchor. This tensioning step causes the length of the anchor to contract vertically and the anchor is simultaneously expanded circumferentially to fill the pocket previously created by the drill. Since the pocket created by the drill is intended to contain the deployed anchor, the deployed position of the anchor is consistently predictable.

This application claims the benefit under 35 U.S.C. 119(e) of the filingdate of Provisional U.S. Application Ser. No. 61/923,591, entitledAll-Suture Suture Anchor, filed on Jan. 3, 2014, which application isherein expressly incorporated herein by reference, in its entirety.

BACKGROUND OF THE INVENTION

There are many soft-tissue to bone repair procedures, such as rotatorcuff, SLAP and Bankart lesion repairs, or reconstruction of labraltissue to the glenoid rim, in which a surgeon needs to secure tissue inclose contact with bone by implanting an anchor, pre-loaded with suture,into a hole drilled in the bone at the desired anchor location.Commonly, the anchor which the sutures are attached to is made of eitherplastic such as PEEK or metal such as Titanium or Stainless Steel. Inthe case of an implant pulling out of the bone there is a piece of hardmaterial from that implant floating inside the joint space. That pieceof material could temporary or permanently be stuck within the joint,causing damage to the articulating surfaces.

Many surgeons are beginning to favor using all-suture suture anchorsover traditional suture anchors. One particular advantage of using anall-suture anchor is that it requires a smaller hole to be drilled tothe bone. Preserving bone is preferred by surgeons. There are quite afew all-suture anchor designs on the market today intended to capturethis trend.

The JuggerKnot™, by Biomet, has its anchor configuration made of asection of #5-polyester suture. The loaded suture is inserted throughthe length of the #5 suture section of the anchor. The anchor ispreloaded on an inserter at the middle point. The inserter pushes theanchor into a drilled hole in the bone until a desired position isreached. The inserter is then removed. Both suture limbs are lightlypulled to contract the anchor, expanding it laterally against the wallof the drilled hole. This design relies on the friction between thesuture ball of the anchor and the bone. Depending upon the positioninside the hole to which the anchor is deployed or set, anchor slippagemay occur when higher tension applied on the anchor until the anchor maymove to a harder bone surface such as the cortex.

ConMed Linvatec also has introduced an anchor called the Y-Knot™. Theanchor is very much the same construct as the Biomet JuggerKnot anchorin terms of design, but with different suture material. It useshigh-strength suture for the anchor instead of polyester suture. Thetechnique for using the anchor is also very similar as the companysuggests in its own words: “Drill Pilot Hole, Insert Anchor, and Pull-toset.” Since the anchor designs and techniques are similar, the anchorshares the same weakness of relying on friction. Thus, slippage canoccur, and pull out strength could not be adequate.

Another similar anchor is from Stryker and is called Iconix™. The anchoris designed to have opening sections along the sheet portion, whichclaim to provide a bunching effect using targeted compression zones. Themiddle point of the anchor is also preloaded on an inserter and insertedinto a pre-drilled hole. When deployed by applying tension on thepre-loaded suture limbs, instead of the whole section of the anchorexpanding randomly within the hole, those opening sections on the anchorare intended to swing outward laterally up to 3 mm-4 mm. However, suchclaimed expansion dimensions are theoretical only, because the softsuture is not stiff enough to penetrate the hole to achieve suchdimensions in practice.

SUMMARY OF THE INVENTION

The following disclosure describes the design for a novel all-suturesuture anchor together with the associated delivery accessories andmethods which are intended to secure tissue to bone. The all-sutureanchor eases this concern and gives surgeons piece of mind, because whenan all suture anchor pulls out, there is only a piece of soft sutureleft in the joint.

This invention is described as a system which consists of a uniquelyconstructed anchor, and inserter, and a specially designed drill. Thedrill is used to enlarge the hole and create a pocket under the bonesurface from the pre-drilled hole. The created pocket is intended toaccommodate the expansion of the anchor when deployed into the bone,generating a true mechanical interference under the bone surface. Theanchor is loaded on the inserter and placed at full length verticallyinside the drilled hole. While holding the inserter on top of thedrilled hole, so that a feature on the inserter keeps the anchor to adesired depth below the bone surface, tension is applied to the suturelimb that is connected to the bottom end of the anchor. This tensioningstep causes the length of the anchor to contract vertically and theanchor is simultaneously expanded circumferentially to fill the pocketpreviously created by the drill. Since the pocket created by the drillis intended to contain the deployed anchor, the deployed position of theanchor is consistently predictable. The interference of the deployedanchor underneath the bone surface guarantees superior pull out strengthand repeatability.

The invention described is a system that allows a surgeon to create abone-to-soft tissue repair with an all-suture anchor and at the sametime, achieve a pull out strength equivalent to the commonly usedplastic or metal screw-in anchor.

More particularly, there is provided an all-suture suture anchoringsystem, which comprises a suture anchor fabricated entirely of a suturematerial, including connected suture links forming a length of thesuture anchor and a preloaded suture woven through the links, andfurther comprising a tensioning suture limb extending from one end ofthe suture anchor. The suture anchoring system further includes aninserter for inserting the suture anchor into a bone hole, the insertercomprising an outer tube, a distal end extending distally from the outertube, and an internal push rod disposed within said inserter, whereinthe distal end includes a chamber for containing the suture anchortherein and is movable proximally to retract telescopically into theouter tube and distally to extend telescopically from the outer tube.

The outer tube further comprises a distal edge for contacting the bonesurface and functioning as a stop when the inserter is being insertedinto a bone hole. The internal push rod is fixed to the outer tube andhoused inside both of the outer tube and the distal end, the internalpush rod is configured to extend distally a short distance beyond adistal end of the outer tube. The suture anchor is disposed within thechamber, and a distal end of the internal push rod contacts a proximalend of the suture anchor. When the distal end is retracted proximallyinto the outer tube, the push rod pushes the suture anchor out of thedistal end of the inserter.

The connected links of the suture anchor are each formed by tiedalternating half-hitch knots, using two strands of suture material.

The system further includes a drill assembly, comprising an outer sleeveand a cutting blade housed within the outer sleeve. The outer sleevecomprises a window disposed through a portion thereof. The cutting bladeis pivotally attached to the outer sleeve, so that the cutting blade maybe pivoted between a retracted orientation, wherein it is housed withinan outer diameter of the outer sleeve, and an extended orientation,wherein the cutting blade extends outwardly of the outer sleeve, throughthe window.

The drill assembly further includes an actuator for actuating thecutting blade between its retracted and expanded orientations. Theactuator comprises a control rod housed within the outer sleeve andmovable axially between proximal and distal positions, so that when thecontrol rod moves distally, an actuating surface on the control rodcontacts the cutting blade to cause it to pivot outwardly, and when thecontrol rod moves proximally, the actuating surface ceases contact withthe cutting blade so that the blade pivots back into the outer sleeveand its retracted orientation.

In another aspect of the invention, there is provided a drill assemblyfor forming a hole in bone or another procedural site, for implantationof a bone anchor. The drill assembly comprises an outer sleeve, acutting blade housed within the outer sleeve, wherein the cutting bladeis pivotally attached to the outer sleeve, and an actuator for pivotingthe cutting blade between retracted and expanded orientations. The outersleeve comprises a window disposed through a portion thereof, whereinwhen the cutting blade is in its retracted orientation, it is housedwithin an outer diameter of the outer sleeve, and when the cutting bladeis in its extended orientation, the cutting blade extends outwardly ofthe outer sleeve, through the window. The actuator comprises a controlrod housed within the outer sleeve and movable axially between proximaland distal positions, so that when the control rod moves distally, anactuating surface on the control rod contacts the cutting blade to causeit to pivot outwardly, and when the control rod moves proximally, theactuating surface ceases contact with the cutting blade so that theblade pivots back into the outer sleeve and its retracted orientation.

In still another aspect of the invention, there is disclosed a method ofanchoring soft tissue to a suitable bone site, using an all-suturesuture anchor. The method comprises steps of creating a pre-drilledpilot hole having a first diameter, inserting a drill assembly into thepre-drilled hole to a desired depth, moving an actuator to pivot acutting blade from a retracted position within an outer diameter of anouter sleeve of the drill assembly to an expanded position extendingoutside of the outer diameter of the outer sleeve, and rotating theouter sleeve (using the drill) to create a pocket in the bone sitebeneath the pre-drilled pilot hole, the pocket having a second diametergreater than the first diameter. Once the pocket is fully created, thenext step is to collapse the cutting blade to its retracted position,and to remove the drill assembly from the bone hole. An anchor inserteris then inserted into the bone hole and pocket, wherein the anchorinserter comprises an outer sleeve housing the all-suture suture anchor,after which the suture anchor is released within the pocket byretracting a distal tip of the anchor inserter. Then, tension is appliedto a suture limb extending from the anchor to contract the anchorvertically, thereby causing the anchor to expand horizontally to contactopposing edges defining the pocket, so that the suture anchor is widerthan the first diameter.

The invention, together with additional features and advantages thereof,may best be understood by reference to the following description takenin conjunction with the accompanying illustrative drawing.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a view showing one embodiment of an all-suture anchorconstruct with eight links, constructed in accordance with theprinciples of the present invention;

FIGS. 2 and 3 illustrate the anchor construct of FIG. 1, with apreloaded length of suture woven through the loops thereof to make acomplete anchor assembly;

FIG. 4 illustrates a distal end of one embodiment of an inserterconstructed in accordance with the principles of the present invention;

FIG. 5 is a view similar to FIG. 4, wherein the distal end has beenloaded with an anchor according to the invention;

FIG. 6 is a view similar to FIGS. 4-5, showing the distal end in anextended position;

FIG. 7 is a view similar to FIGS. 4-6, wherein the distal end has beenretracted proximally into an outer tube of the inserter;

FIG. 8 is a view illustrating a push rod disposed within the inserter,visible with the distal end in its retracted position;

FIG. 9 is a view similar to FIG. 8 illustrating the push featurecontacting the preloaded anchor;

FIG. 10 is a schematic view illustrating a bone site for use inconnection with the inventive anchor and drill system;

FIG. 11 is a view illustrating one embodiment of a drill assemblyaccording to the invention;

FIG. 12 is a cross-sectional view of the drill assembly of FIG. 11;

FIG. 13 is a view showing a drill sleeve of the drill assembly of FIGS.11 and 12;

FIG. 14 is a view illustrating an inner control rod of the drillassembly of FIGS. 11 and 12;

FIG. 15 is a view showing a cutting blade of the drill assembly of FIGS.11 and 12;

FIG. 16 is a view showing the cutting blade of the drill assembly in apushed-out extended orientation;

FIG. 17 is a view showing the cutting blade removing bone at aprocedural site;

FIG. 18 shows a pocket created below bone surface using the inventivesystem;

FIG. 19 shows a pre-drilled pilot hole in the bone surface;

FIG. 20 is a view showing the drill assembly being inserted into thepilot hole of FIG. 19;

FIG. 21 is a view similar to FIG. 20 wherein the drill has been fullyinserted into the pilot hole;

FIG. 22 is a cut-away view showing the drill within the created hole inthe bone site;

FIG. 23 is a view similar to FIG. 22 showing the cutting blade in itsextended orientation;

FIG. 24 is a view of the bone hole wherein a pocket has been created;

FIG. 25 illustrates the inserter with loaded anchor;

FIG. 26 is a view illustrating the inserter inserted into the bone holeuntil abutting a stop;

FIG. 27 illustrates the inserter and loaded anchor inside the bone hole;

FIG. 28 shows a step of the inventive method wherein the anchor isplaced within the created bone hole;

FIG. 29 is a view showing the step applying tension to a suture limb ofthe bone anchor; and

FIG. 30 is a view showing the anchor forming a ball shape beneath thebone surface.

DETAILED DESCRIPTION OF THE INVENTION

Referring now more particularly to the drawings, there is shown in FIG.1 a suture anchor 10 comprised entirely of a suture material. In theillustrated embodiment, the anchor 10 includes eight connected suturelinks 12. The linkage 10, formed of the links 12, is created by tyingtwo alternating half hitches using two strands of #2 high strengthsuture. The two suture strands continue to form a small loop, thenfollowed by two alternating half hitches. As shown in FIG. 2, apreloaded suture 14 is woven through the links or loops 12 on the anchor10 to make a complete anchor assembly. As shown in FIG. 3, a tensioningsuture limb 16 extends from one end of the anchor 10.

Now with reference to FIGS. 4-9, in particular, details of an inserter18 for use in the inventive system are shown. The inserter 18 comprisesthree main elements. These elements include an inserter distal end 20(FIGS. 4 and 5), an outer tube 22 (FIGS. 6-8), and an internal push rod24 (FIGS. 8 and 9). The distal tip or end 20 houses the anchor 10 (FIG.5) during insertion into a drilled hole in the bone site. This distalsection 20 is constructed, in the illustrated embodiment, of thin walltubing with a chamber 26 having an internal diameter (ID) that fits theprofile and length of the anchor 10, as shown in FIGS. 4 and 5.

The outer tube 22 functions as a telescoping mechanism for the distalend 20 to retract proximally in order to release the anchor 10 from thechamber 26. During insertion into a bone hole, a distal end 28 of theouter tube 22 also stops on the bone surface, indicating to thepractitioner that the desired depth has been reached.

The small internal push rod 24 is fixed to the outer tube 22, housedinside both of the distal and the outer tubes 20, 22, respectively, ofthe inserter 18, and configured to protrude distally a few millimetersfrom the end of the outer tube 22, as shown in FIG. 8. This built-infeature is adapted to contact the proximal end of the preloaded anchor10. When the distal end 20 retracts into the outer tube 22, this pushrod 24 pushes the anchor 10 out of the distal end of the inserter 18.

A rotating mechanism such as a wheel or a knob is attached to theinserter 18 to help apply enough tension on the preloaded suture limb 16to completely deploy the anchor. The tensioning suture limb 16 isattached to this mechanism to ensure that tension is always applied onthat suture limb.

Another aspect of the present invention is the provision of a drillsystem suitable for creating a bone hole configuration such as thatshown in FIG. 10. As illustrated, a procedural site is selected insuitable bone 30. A pre-drilled hole 32 is formed on bone surface 34.The goal of the drilling system is to be able to insert the drill intothe pre-drilled hole 32, and to enlarge the hole at a certain depthbeneath the bone surface 34 (or cortex) to create a pocket 36. Adiameter 38 of the pocket 36 is substantially larger than a diameter 40of the pre-drilled hole 32, as is evident from FIG. 10.

As shown in FIGS. 11-16, the drill assembly 42 of the present inventioncomprises three main components. These components include an outersleeve 44 having a cut window 46, an inner control rod 48 and a cuttingblade 50. When the control rod 48 is in the position shown in FIG. 12,the cutting blade 50 is secured from pivoting or swinging outwardlythrough the cut window 46 about a pivot attachment 52, comprising a hole52 in the outer sleeve 44 and a pin 52 or the like attached to the bladeand secured to the outer sleeve through the hole, by means of which thecutting blade 50 is pivotally attached to the outer sleeve 44. Thus, inthis orientation, the cutting blade 50 resides within the outer diameter(OD) of the outer sleeve 44, tucked within a suitably sized recess ordrill-controlled feature 54 (FIGS. 12, 14, and 16). Since the outersleeve 44 is of approximately the same diameter as the diameter 40 ofthe pre-drilled hole 32, it can be inserted into the hole 32. Onceinserted to the desired depth, beneath the cortical bone surface 34, thecontrol rod 48 is pushed distally, so that an actuating surface 56contacts the inside edge of the blade 50 and pushes it outwardly, asshown in FIG. 16, causing it to pivot about the pivot joint 52 to anexpanded orientation. FIG. 17 illustrates this orientation, and showshow the blade 50 in its expanded orientation forms the pocket 36. WhileFIG. 18 illustrates the pocket 36 once formed, with the drill removed.

FIGS. 19-30 illustrate, in sequence, a representative method for usingthe inventive system to secure an anchor 10 in place. In thisrepresentative method; a first step is to create a pre-drilled pilothole 32 in the cortical bone surface 34 (FIG. 19). The hole 32 istapped, if necessary. Then, the drill assembly 42 is inserted into thepilot hole 32 (FIGS. 20 and 21), once it is verified that the cuttingblade 50 is fully collapsed inside the window 46 on the outer sleeve 44.The distal end is inserted into the hole until a marking 58 on the outersleeve 44 is level with the bone surface 34, or, alternatively, a drillguide or other visualization or detection approach is used to controlthe depth (FIG. 22).

When the predetermined desired depth has been reached, the control rod48 is pushed distally, as shown in FIG. 23, until it firmly stops, thuspivoting the blade 50 to its fully extended or expanded orientation. Atthis point, the drill may be activated to rotate the bit and cause theblade 50 to form the pocket 36, as shown in FIGS. 23 and 24. Again, adrill guide can be used to control the depth.

Once the pocket 36 has been fully formed, the control rod 48 is pulledproximally all the way up until it firmly stops to fully collapse thecutting blade 50 into the outer sleeve 44. Then, the drill is removedfrom the hole (FIG. 24).

At this point, the inserter tip 20 with loaded anchor 10 (FIG. 25) isinserted into the hole until the distal end 28 of the outer tube 22abuts the cortical bone surface 34 to serve as a stop for thepractitioner. This is shown in FIG. 26. FIG. 27 illustrates the inserterand loaded anchor inside the bone hole. While holding the inserter downagainst the bone surface, the distal end (tip) 20 is retracted torelease the anchor 10 inside the hole (FIG. 28). The anchor is nowproperly placed in the hole with the created pocket, and is ready to bedeployed.

Applying tension on the indicated suture limb 16 causes the anchor 10 tocontract vertically, as shown in FIG. 29, and deploys the anchor out tothe edges of the pocket 36, as shown. The upper end of the anchor iseither caught by the edge of the top lip of the pocket, or stopped bythe stopping feature of the inserter while the applied tension ispulling the anchor up. This prevents the anchor from pulling through thehole 32, and forces it to expand circumferentially under the appliedtension. FIG. 29 illustrates the anchor in a partially deployedorientation. When completely deployed, as shown in FIG. 30, with theinserter removed from the procedural site, the anchor 10 forms a ballshape beneath the bone surface, filling up the pocket 36 and creating amechanical blockage through the smaller hole 32 on the bone surface 34.The tensioning suture limb is attachable to soft tissue to be secured tothe bone surface 34, for anchoring the soft tissue to the bone.

Accordingly, although exemplary embodiments of the invention has beenshown and described, it is to be understood that all the terms usedherein are descriptive rather than limiting, and that many changes,modifications, and substitutions may be made by one having ordinaryskill in the art without departing from the spirit and scope of theinvention.

What is claimed is:
 1. A method of delivering an all-suture sutureanchor to a bone site, comprising: creating a pre-drilled bone hole inan outer bone surface, the bone hole including a first portion definedby a first internal diameter and a second portion defined by a secondinternal diameter that is greater than the first internal diameter;aligning an anchor inserter with the bone hole, the anchor inserterincluding an outer sleeve, a distal end portion extending distallybeyond a distal end of the outer sleeve, and an internal push roddisposed within the outer sleeve and coupled to the outer sleeve in afixed longitudinal position, wherein the suture anchor is preloaded intoa chamber of the distal end portion; positioning the distal end portionof the anchor inserter within the bone hole such that the distal end ofthe outer sleeve contacts the outer bone surface; deploying the sutureanchor within the second portion of the bone hole by retracting thedistal end portion into the outer sleeve of the anchor inserter; andapplying tension to a suture limb extending from the suture anchor toexpand the suture anchor in the second portion of the bone hole; whereinapplying tension to the suture limb extending from the suture anchorcontracts the suture anchor vertically, thereby causing the sutureanchor to expand horizontally in the second portion of the bone hole toa width that is greater than the first internal diameter.
 2. The methodof claim 1, wherein the width is substantially equal to the secondinternal diameter.
 3. The method of claim 1, wherein the suture anchorexpands horizontally by an amount sufficient to cause contact betweenthe suture anchor and a second inner wall of the second portion.
 4. Themethod of claim 1, wherein the suture anchor is fabricated entirely of asuture material and comprises a plurality of suture links, a pre-loadedsuture woven through the links, and the suture limb extending from thesuture anchor.
 5. The method of claim 1, wherein retracting the distalend portion of the anchor inserter causes the internal push rod to pushthe suture anchor distally out of the anchor inserter.
 6. The method ofclaim 1, wherein creating the bone hole comprises drilling a pilot holehaving the first internal diameter.
 7. The method of claim 6, whereincreating the bone hole further comprises: inserting a drill assemblyinto the pilot hole to a desired depth; moving an actuator to pivot acutting blade from a retracted position within an outer diameter of anouter sleeve of the drill assembly to an expanded position extendingoutside of the outer diameter of the outer sleeve; and rotating theouter sleeve to enlarge the pilot hole from the first internal diameterto the second internal diameter, thereby forming the first and secondportions of the bone hole.
 8. The method of claim 7, wherein creatingthe bone hole further comprises: collapsing the cutting blade to theretracted position; and removing the drill assembly from the bone hole.9. A method of delivering an all-suture suture anchor to a bone site,comprising: aligning an anchor inserter with a pre-drilled bone holeformed in an outer bone surface, the bone hole including a first portiondefined by a first internal diameter and a second portion defined by asecond internal diameter that is greater than the first internaldiameter, the anchor inserter including an outer sleeve, a distal endportion extending distally beyond a distal end of the outer sleeve, andan internal push rod disposed within the outer sleeve and coupled to theouter sleeve in a fixed longitudinal position such that a spacingbetween a distal end of the internal push rod and the distal end of theouter sleeve remains constant, wherein the suture anchor is preloadedinto a chamber of the distal end portion; positioning the distal endportion of the anchor inserter within the bone hole such that the distalend of the outer sleeve contacts the outer bone surface; deploying thesuture anchor within the second portion of the bone hole by retractingthe distal end portion into the outer sleeve of the anchor inserter; andapplying tension to a suture limb extending from the suture anchor toexpand the suture anchor in the second portion of the bone hole.
 10. Themethod of claim 9, wherein the first portion of the bone hole extendsfrom the outer bone surface to a first depth, and the second portion ofthe bone hole extends from the first depth to a second depth greaterthan the first depth.
 11. The method of claim 10, wherein positioningthe distal end portion of the anchor inserter within the bone holecomprises inserting the distal end portion through the first portion ofthe bone hole and into the second portion of the bone hole.
 12. Themethod of claim 11, wherein the suture anchor expands to a width that isgreater than the first diameter, thereby preventing movement of thesuture anchor out of the second portion of the bone hole.
 13. The methodof claim 11, wherein the suture anchor is fabricated entirely of asuture material and comprises a plurality of suture links, a pre-loadedsuture woven through the links, and the suture limb extending from thesuture anchor.
 14. The method of claim 9, wherein retracting the distalend portion into the outer sleeve causes the internal push rod to pushthe suture anchor distally out of the anchor inserter.
 15. The method ofclaim 14, wherein the internal push rod extends distally beyond thedistal end of the outer sleeve.
 16. The method of claim 9, wherein thesuture anchor expands by an amount sufficient to cause contact betweenthe suture anchor and an internal wall of the bone hole.
 17. The methodof claim 9, further comprising: drilling the bone hole into the outerbone surface at the bone site, the bone hole having the first internaldiameter; inserting a drill assembly into the bone hole; operating thedrill assembly to enlarge the bone hole at a desired depth below theouter bone surface, thereby creating the second portion having thesecond internal diameter; and removing the drill assembly from the bonehole.
 18. A method of delivering an all-suture suture anchor to a bonesite, comprising: aligning an anchor inserter with a pre-drilled bonehole formed in an outer bone surface, the bone hole including a firstportion defined by a first internal diameter and a second portiondefined by a second internal diameter that is greater than the firstinternal diameter, the anchor inserter including an outer sleeve, adistal end portion extending distally beyond a distal end of the outersleeve and slidable relative to the outer sleeve, and an internal pushrod disposed within the outer sleeve and coupled to the outer sleevesuch that a distal end of the internal push rod and the distal end ofthe outer sleeve are spaced apart by a fixed longitudinal distanceduring a delivery operation; positioning the distal end portion of theanchor inserter within the bone hole such that the distal end of theouter sleeve contacts the outer bone surface; deploying the sutureanchor within the second portion of the bone hole by retracting thedistal end portion into the outer sleeve of the anchor inserter, therebycausing the internal push rod to push the suture anchor distally out ofthe anchor inserter; and expanding the suture anchor in the secondportion of the bone hole.